Romania

2006: Reimbursement of anti-dementia drugs

The availability of medicines in general

A positive list of medicines to be reimbursed is compiled annually by the Ministry of Health and the National Health Insurance. This list determines which prescription drugs are covered by health insurance funds. The list is based on recommendations from the College of Physicians and the College of Pharmacists.

The reimbursement list applies to inpatients and outpatients. In fact, there are two lists: one containing substances that are 100% reimbursable for people suffering from one or more of a list of diseases (cancer, tuberculosis, diabetes, etc.); the other containing other substances on which the reference price system is applied and of which 70% of the reference price is reimbursed.[1]

The availability of Alzheimer treatments

With the exception of galantamine, all other anti-dementia drugs are available and reimbursable in Romania. Unlike other countries, donepezil is also indicated for the treatment of vascular dementia and can be reimbursed in those cases as well.

Treatment initiation and treatment continuation are restricted to specialists only (neurologists, psychiatrists or old age psychiatrists). The National Health Insurance approved guidelines that are in existence in Romania which prescribe a series of examinations that need to be carried out when making a diagnosis (neuropsychological tests, CT or MRI scans and laboratory tests). For Alzheimer medicines to be reimbursed, these tests need to be carried out and included in a medical report.

Until recently, the system did not prescribe any upper or lower treatment limits, but in some areas of the country, the Romanian Alzheimer Society reports that health insurance offices have restricted reimbursement to people with Alzheimer’s disease with an MMSE score over 12.

Although there are no restrictions for people living alone or for people living in nursing homes, the Romanian Alzheimer Society reports difficulties for these people in accessing medication due to a lack of social support.